右美托咪啶复合靶控输注丙泊酚用于无痛人工流产术的观察

Application of dexmedetomidine combined with target-controlled infusion with propofol in painless artificial abortion

目的探讨右美托咪啶复合靶控输注（TCI）丙泊酚用于无痛人工流产术的有效性及安全性。方法拟行无痛人工流产手术患者120例,随机分为观察组和对照组各60例。对照组患者开始以血浆靶浓度（Cp）为4~5 mg.L-1TCI丙泊酚,逐渐增加至6~7 mg.L-1,当患者睫毛反射消失时减至4~5 mg.L-1;观察组在TCI丙泊酚前缓慢静脉推注（超过5 min）右美托咪啶0.5μg.kg-1。记录术前（T1）、睫毛反射消失时（T2）、扩宫时（T3）、吸宫时（T4）和手术结束时（T5）的平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）值;记录丙泊酚的总用量、诱导时间、唤醒时间和定向力恢复时间;并观察术中患者体动反应、呼吸抑制及术后宫缩痛情况。结果观察组T2、T3、T4时的HR较T1时明显减慢,差别有统计学意义（P〈0.05）;对照组T2、T3、T4时的MAP、SpO2均较T1时显著降低,差别有统计学意义（P〈0.05）。组间比较显示,T2、T3时对照组的MAP、SpO2明显低于观察组,T2、T3、T4时对照组的HR明显高于观察组,差别有统计学意义（P〈0.05）;观察组的诱导时间、唤醒时间及定向力恢复时间明显比对照组缩短,丙泊酚总用量比对照组减少,差别均有统计学意义（P〈0.05）。观察组的呼吸抑制、术后宫缩痛及术中体动反应发生率明显低于对照组,差别有统计学意义（P〈0.05）。结论右美托咪啶0.5μg.kg-1复合TCI丙泊酚应用于无痛人工流产手术安全有效。

Objective To evaluate the safety and validity of dexmedetomidine combined with target-controlled infusion（TCI） with propofol in painless artificial abortion.Methods One hundred and twenty patients who were undergoing painless artificial abortion were randomly divided into observation group and control group,sixty cases in each group.The initial target plasma concentration（Cp） in control group was set at 4-5 mg·L-1,then increased to 6-7 mg·L-1,but it was decreased to 4-5 mg·L-1 when eyelash reflex vanished.The patients in observation group received dexmedetomidine 0.5 μg·kg-1 before TCI with propofol.Mean arterial pressure（MAP） of preoperative（T1）,eyelash reflex vanishing（T2）,enlarging cervix（T3）,pulling（T4） and the end of operation（T5）,heat rate（HR）,pulse oxygen saturation（SpO2）,the propofol consumption,induction time,awake time,orientation recovery time were recorded,and the rates of patients′ body motion and respiratory depression and postoperative uterine contraction pain also were observed.Results HR at T2,T3,T4 was significantly lower than that at T1 in observation group（P0.05）.MAP and SpO2 at T2,T3,T4 were significantly lower than those at T1 in control group（P0.05）.Compared between the two groups,MAP and SpO2 at T2,T3 in control group were significantly lower than those in observation group,HR at T2,T3,T4 in control group were significantly higher than that in observation group（P0.05）.The propofol consumption,Induction time,awake time and orientation recovery time in observation group were significantly less than those in control group（P0.05）.The rates of patients′ body motion,respiratory depression and postoperative uterine contraction pain in observation group were significantly less than those in control group（P0.05）.Conclusion The application of 0.5 μg·kg-1dexmedetomidine combined TCI with propofol in painless artificial abortion is safe and valid.